HomeMy WebLinkAbout2022 Sign off Transmittal - Change back to 2 Units TOWN OF YARMOUTH
HEALTH DEPARTMENT
g.t• PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
- - 556 6' Pip
To he completed by Applicant:
Building Site Location: 39 e&b.r) Zocc(
Proposed Improvement: 7 CJi'11•Jr
Applicant: i2.057 ) gy111 Tel. No. r%-�1T�
Address: Date Filed:
**/fyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: (PPlibit0G2I LB9C
Owner Address: O&M ten) IL e Owner Tel. Not! -5 2-- 32Zg
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: / _ , -- _ • DATE: g---€„?ye-clz
PLEASE NOTE
COMMENTS/CONDITIONS: